Provider Demographics
NPI:1871198770
Name:CUNNINGHAM, TIEYERA HALI (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIEYERA
Middle Name:HALI
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 TOWER CIR APT 231
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1523
Mailing Address - Country:US
Mailing Address - Phone:513-349-8557
Mailing Address - Fax:
Practice Address - Street 1:2788 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2004
Practice Address - Country:US
Practice Address - Phone:615-367-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist